Nuts and Bolts: Positive Deviance

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June 07, 2016

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“In every group there is a minority of people who find better solutions to the challenges at hand. … Even though they have access to exactly the same resources as the rest of the group, their uncommon practices or behaviors allow them to flourish.”—Jerry Sternin

While “positive deviance” is a fun, alluring term, it’s not about just breaking rules. The “deviance” must have a positive outcome. It’s not quite just innovation or creative thinking, though those can certainly be part of it. It’s not just a random act of kindness, like paying for the coffee of the next customer in line. It’s more about deploying uncommon but successful behaviors or strategies to achieve some better result.

In 1990, Jerry Sternin, director of Save the Children in Vietnam, was tasked with finding a sustainable solution for overcoming the problem of child malnutrition. At the time, 65 percent of the children under age five in Vietnamese villages were malnourished. Prior attempts to implement solutions—such as supplemental feeding programs—did not succeed for long. Along with his wife, Monique, Jerry looked at a question that researchers were working on at Tufts: “Why, with all resources being equal, are some children in a community not malnourished?” Working in four communities, the Sternins turned to the members of poor villages who seemed to overcome the malnutrition problem and have healthier children. There emerged a group of positive deviants, the families who, despite identical resources, were able to achieve better outcomes through doing things others did not. It turned out those families were giving more frequent meals than was the custom, and were feeding items—such as brine shrimp and crab—considered inappropriate for young children.

It isn’t about imposing solutions, but helping the community surface the solution it already has

You know the drill: Organization has a problem. Organization brings in “experts” to study the problem, devise a solution, run a pilot (which may mean a training program), and then leave. Organization members quickly revert back to old behaviors.

The solution in Vietnam was sustained precisely because the solution was not just imposed on the villagers. The Sternins didn’t go around lecturing about feeding more frequent meals and unusual foods. They leveraged the help of community members—the mothers of the healthier children—in working directly with other families to spread the different practices. Ultimately, the initiative cut childhood malnutrition by two-thirds because the families sustained the change.

What are positive deviants like?

They see the holes, not the net

Where others saw constraints—food sitting there yet regarded as unusable—the mothers in Vietnam saw protein. Years ago, in my own organization, we saw the opportunities eLearning offered to solve some of our real problems, but there were just no funds to be had. So we looked past that net to a hole: “What can we do without money?” The answer ended up involving things like basic HTML pages, but we launched a program. Where a friend was told he couldn’t supplement classroom training with social tools—because the organization blocked Facebook—he found other tools that the organization would allow, some already getting heavy use from workers.

They have a low regard for social convention

Have you ever felt the fallout from trying to change a seemingly innocuous tradition in your own family? The mothers in Vietnam were feeding foods in defiance of community norms and traditions maintained by village elders. Positive deviants push the limits and check the edges of usual practice.

They tend to be passionate about their work and act from a sense of greater purpose

Positive deviants are not trying just to execute tasks but to contribute to a greater goal. They don’t see themselves as just breaking up rock, but as helping to build a cathedral.

A quick start? Flip the question

As you saw with the Sternins, a key behavior of positive deviants is their ability to reframe the question. Instead of asking, “Why are so many children malnourished?,” they asked: “Why are these other children not malnourished?”

Other examples:

Not “How can we stop distracted driving?” but “How can we make cars safer?” Even inexpensive new cars have sensors that prevent following too closely and that offer help with staying in lanes.

Not “How can we get money?” but “What can we do with no money?”

Not “How can we force people to finish courses?” but “How can we make the courses more interesting and worthwhile?”

Years ago, I was working with a hospital for adults with developmental disabilities, where I supervised the staff who taught emergency response courses. All workers were required to be regularly recertified in standard first aid, and we had a terrible time getting this done. In most instances, the ever-present nursing staff handled emergencies, so other staff did not perceive recertification as a high priority. Getting people to class involved a lot of foot-dragging, endless floor-coverage issues, last-minute cancellations, and even threats. One of my staff suggested that we start adding on infant and child CPR at the end of the training day. It didn’t cost us anything, as we already had staff and equipment to do it, and by trimming down breaks we didn’t extend the day by much. It solved our attendance problem overnight, as the training was suddenly seen as more valuable to the parents and grandparents who constituted a huge proportion of our audience.

The related field of appreciative inquiry offers similar flip-the-question approaches but is more specific, asking us to look for and build on the positive case or “outlier.” Is there someone in the community already exhibiting the desired behavior? What is enabling them to outperform? What resources are they tapping into that others are not?

Not “Why are staph infections so high in the hospital?” but “Why are staph infections lower on the third floor?”

Not “Why are sales down in Regions 6 and 9?” but “Why are sales up in Region 4?”

Not “Why do so few graduates of our leadership academy get promoted?” but “Why did these seven graduates get promoted?”

Why is the accident rate lower in _______? Why is the turnover rate lower in ______? Why are there fewer ethics complaints about ______ division?

I was speaking at a conference the other day when a participant said, “We would really like to see more female executives. We’ve gathered lots of data about why they are hesitant to move into management, like possible relocation, but we don’t seem to be getting anywhere.” Flip the question: Instead of talking to the women who are resistant, talk to the ones who were not. What worked for them? What challenges did they face, and how did they overcome them? What supports were in place? And finally, use the community: How can they help you with this?

Think about behaviors, about practice over knowledge, and about things that can be done today. The Sternins were given six months to work on the malnutrition problem. Sure, most things are complex with interlocking and underlying pieces. But find something you can work on today. Help “communities,” whatever they are, discover their own solutions

Think about your resources. Money, sure, but what about people, tools, ideas, space? Back in our late-1990s “how do we do eLearning without money?” days, I found that I had many more assets at my disposal than I’d first considered, including a co-worker who had once been a radio DJ so had a great, polished voice; an office copy of Dreamweaver, which at the time had a challenging but useful add-on interaction-creation tool called CourseBuilder; a stockpile of not-too-old VHS training tapes for which we’d bought reproduction rights and the right to edit; and a friend with a machine at home that could convert VHS tapes to digital formats.

Finally: Think about community. While there are individual positive deviants who work alone, a key factor is working with the community to surface, spread, and sustain solutions rather than try to force outside-in answers—as is so often the case with training. I frequently meet designers who say they do not—or are not allowed to—talk with workers who will be their target audience. Often the workers are the ones who have the better answer, know whether the proposed solution is already in place somewhere, and can help you get at the real issues. Try to get access to and build regular contact with the communities of workers you ultimately serve. Leveraging social tools and workplace communities, and encouraging people to show their work, can help to surface and spread solutions and to sustain application of new learning to the workplace.

Want more?

Gawande, Atul.Better: A Surgeon’s Notes on Performance. New York: Picador, 2008. (Note especially his five steps for becoming more like a positive deviant.)

Marra, Alexandre, et al. Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance.Infection Control and Hospital Epidemiology, Vol. 31, No. 1. January 2010. (Conclusion: A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of hospital-acquired infections.)

Nuts and Bolts: Positive Deviance

Topics

“In every group there is a minority of people who find better solutions to the challenges at hand. … Even though they have access to exactly the same resources as the rest of the group, their uncommon practices or behaviors allow them to flourish.”—Jerry Sternin

While “positive deviance” is a fun, alluring term, it’s not about just breaking rules. The “deviance” must have a positive outcome. It’s not quite just innovation or creative thinking, though those can certainly be part of it. It’s not just a random act of kindness, like paying for the coffee of the next customer in line. It’s more about deploying uncommon but successful behaviors or strategies to achieve some better result.

In 1990, Jerry Sternin, director of Save the Children in Vietnam, was tasked with finding a sustainable solution for overcoming the problem of child malnutrition. At the time, 65 percent of the children under age five in Vietnamese villages were malnourished. Prior attempts to implement solutions—such as supplemental feeding programs—did not succeed for long. Along with his wife, Monique, Jerry looked at a question that researchers were working on at Tufts: “Why, with all resources being equal, are some children in a community not malnourished?” Working in four communities, the Sternins turned to the members of poor villages who seemed to overcome the malnutrition problem and have healthier children. There emerged a group of positive deviants, the families who, despite identical resources, were able to achieve better outcomes through doing things others did not. It turned out those families were giving more frequent meals than was the custom, and were feeding items—such as brine shrimp and crab—considered inappropriate for young children.

It isn’t about imposing solutions, but helping the community surface the solution it already has

You know the drill: Organization has a problem. Organization brings in “experts” to study the problem, devise a solution, run a pilot (which may mean a training program), and then leave. Organization members quickly revert back to old behaviors.

The solution in Vietnam was sustained precisely because the solution was not just imposed on the villagers. The Sternins didn’t go around lecturing about feeding more frequent meals and unusual foods. They leveraged the help of community members—the mothers of the healthier children—in working directly with other families to spread the different practices. Ultimately, the initiative cut childhood malnutrition by two-thirds because the families sustained the change.

What are positive deviants like?

They see the holes, not the net

Where others saw constraints—food sitting there yet regarded as unusable—the mothers in Vietnam saw protein. Years ago, in my own organization, we saw the opportunities eLearning offered to solve some of our real problems, but there were just no funds to be had. So we looked past that net to a hole: “What can we do without money?” The answer ended up involving things like basic HTML pages, but we launched a program. Where a friend was told he couldn’t supplement classroom training with social tools—because the organization blocked Facebook—he found other tools that the organization would allow, some already getting heavy use from workers.

They have a low regard for social convention

Have you ever felt the fallout from trying to change a seemingly innocuous tradition in your own family? The mothers in Vietnam were feeding foods in defiance of community norms and traditions maintained by village elders. Positive deviants push the limits and check the edges of usual practice.

They tend to be passionate about their work and act from a sense of greater purpose

Positive deviants are not trying just to execute tasks but to contribute to a greater goal. They don’t see themselves as just breaking up rock, but as helping to build a cathedral.

A quick start? Flip the question

As you saw with the Sternins, a key behavior of positive deviants is their ability to reframe the question. Instead of asking, “Why are so many children malnourished?,” they asked: “Why are these other children not malnourished?”

Other examples:

Not “How can we stop distracted driving?” but “How can we make cars safer?” Even inexpensive new cars have sensors that prevent following too closely and that offer help with staying in lanes.

Not “How can we get money?” but “What can we do with no money?”

Not “How can we force people to finish courses?” but “How can we make the courses more interesting and worthwhile?”

Years ago, I was working with a hospital for adults with developmental disabilities, where I supervised the staff who taught emergency response courses. All workers were required to be regularly recertified in standard first aid, and we had a terrible time getting this done. In most instances, the ever-present nursing staff handled emergencies, so other staff did not perceive recertification as a high priority. Getting people to class involved a lot of foot-dragging, endless floor-coverage issues, last-minute cancellations, and even threats. One of my staff suggested that we start adding on infant and child CPR at the end of the training day. It didn’t cost us anything, as we already had staff and equipment to do it, and by trimming down breaks we didn’t extend the day by much. It solved our attendance problem overnight, as the training was suddenly seen as more valuable to the parents and grandparents who constituted a huge proportion of our audience.

The related field of appreciative inquiry offers similar flip-the-question approaches but is more specific, asking us to look for and build on the positive case or “outlier.” Is there someone in the community already exhibiting the desired behavior? What is enabling them to outperform? What resources are they tapping into that others are not?

Not “Why are staph infections so high in the hospital?” but “Why are staph infections lower on the third floor?”

Not “Why are sales down in Regions 6 and 9?” but “Why are sales up in Region 4?”

Not “Why do so few graduates of our leadership academy get promoted?” but “Why did these seven graduates get promoted?”

Why is the accident rate lower in _______? Why is the turnover rate lower in ______? Why are there fewer ethics complaints about ______ division?

I was speaking at a conference the other day when a participant said, “We would really like to see more female executives. We’ve gathered lots of data about why they are hesitant to move into management, like possible relocation, but we don’t seem to be getting anywhere.” Flip the question: Instead of talking to the women who are resistant, talk to the ones who were not. What worked for them? What challenges did they face, and how did they overcome them? What supports were in place? And finally, use the community: How can they help you with this?

Think about behaviors, about practice over knowledge, and about things that can be done today. The Sternins were given six months to work on the malnutrition problem. Sure, most things are complex with interlocking and underlying pieces. But find something you can work on today. Help “communities,” whatever they are, discover their own solutions

Think about your resources. Money, sure, but what about people, tools, ideas, space? Back in our late-1990s “how do we do eLearning without money?” days, I found that I had many more assets at my disposal than I’d first considered, including a co-worker who had once been a radio DJ so had a great, polished voice; an office copy of Dreamweaver, which at the time had a challenging but useful add-on interaction-creation tool called CourseBuilder; a stockpile of not-too-old VHS training tapes for which we’d bought reproduction rights and the right to edit; and a friend with a machine at home that could convert VHS tapes to digital formats.

Finally: Think about community. While there are individual positive deviants who work alone, a key factor is working with the community to surface, spread, and sustain solutions rather than try to force outside-in answers—as is so often the case with training. I frequently meet designers who say they do not—or are not allowed to—talk with workers who will be their target audience. Often the workers are the ones who have the better answer, know whether the proposed solution is already in place somewhere, and can help you get at the real issues. Try to get access to and build regular contact with the communities of workers you ultimately serve. Leveraging social tools and workplace communities, and encouraging people to show their work, can help to surface and spread solutions and to sustain application of new learning to the workplace.

Want more?

Gawande, Atul.Better: A Surgeon’s Notes on Performance. New York: Picador, 2008. (Note especially his five steps for becoming more like a positive deviant.)

Marra, Alexandre, et al. Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance.Infection Control and Hospital Epidemiology, Vol. 31, No. 1. January 2010. (Conclusion: A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of hospital-acquired infections.)

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